[ZeroGravitas]

And now the opposite happens with headlines that imply "your medication is suddenly revealed to be useless" when in fact we've been aware that we don't know how it works for a while, but we're still reasonably sure it helps, which perhaps explains the increase in prescription more than the "serotonin is the only thing that matters" theory which the experts ruled out a while ago.

[virtuallynathan]

They barely work better than placebo, from what I saw in my reading of the literature.

[NickM]

There is also evidence that they might only work better than a typical placebo because the side effects make them an "active placebo", triggering a stronger placebo response. i.e. if you take a pill that doesn't make you feel any different, you may wonder if it's working, but if you feel weird and have unpleasant side effects then you know it's doing something.

This is particularly underappreciated in the research done on these drugs, because a double-blind study isn't actually double-blind if many of the participants can easily tell whether they're in the placebo group due to very noticeable side effects.

It's been mentioned in other comments, but I really recommend the work of Irving Kirsch on this; he's a brilliant scientist and his book The Emperor's New Drugs is a real eye-opener.

[swamp40]

They work fantastically, from what I have seen firsthand many many times.

There is a very good reason for it's use in up to 20% of the population in some groups in the US.

Just because we haven't pinpointed why doesn't matter a bit.

[dimal]

“They work fantastically” is a statement that requires many qualifiers.

They work fantastically for some subset of people. For other people, they do nothing. For other people, they have negative side effects that make them not worth whatever benefits they provide. For some people, they cause extreme negative effects when the medication is removed. For some other people, they increase the chance that they will commit suicide.

It does matter that we haven’t pinpointed why they work for some people, because if we did, we might be able to avoid those negative effects and wasted time for the people for which they don’t work.

[marcosdumay]

If the effect is systematic, real, and measurable, it's just a matter of giving the medication to the people that benefit from it, and not giving it to the people that don't.

The real question is by what level is the effect is systematic, real, and measurable?

[bowsamic]

Who should I trust? Peer reviewed literature, or one swampy boi?

[slibhb]

Well, placebos work fairly well for depression. And it's not like doctors can prescribe them...

[jack_pp]

So the solution is prescribing something that has a lot of unpleasant side-effects for a lot of people? Medication that if you don't take will have SEVERE withdrawal symptoms?

[slibhb]

SSRIs have mild side effects after the first few weeks. Withdrawal varies but is generally manageable if you taper slowly.

I'm open to alternatives but I'm convinced that antidepressants help people.

[wins32767]

I suddenly became allergic to SSRIs and had to go off of them cold turkey. I didn't have any withdrawal problems at all so it's not a universal issue.

[niemal_dev]

Wow, just wow. Quitting them cold turkey 0 problems, incredible.

[wins32767]

I'm not trying to minimize the problems other people have had with withdrawal at all, just saying that it's possible to have a variety of different outcomes being on and off of them.

[zasdffaa]

I wonder why you say 'SEVERE' so severely. It doesn't sound like you have any direct experience of this. I had to come off them and it wasn't a problem. My biggest fear, and it was huge, was that the depression would return. It didn't.

[MattRix]

I had horrible withdrawal effects coming off lexapro/escitalopram, it was literally the worst experience of my life. I spent a month with maxed-out anxiety, feeling like I was going to die any moment, waking up at night with electric shocks running through my body, etc. I wouldn’t wish it on my worst enemy.

[zasdffaa]

OK, that's an SSRI which is what I had to come off (prozac), with no major issues.

I'm not at all claiming it's a fun ride for everyone, just giving my one data point that it's not inevitably awful for absolutely everyone. Sorry you had to deal with it!

[guerrilla]

Because it's pretty damned severe with SNRIs. You probably only tried some SSRIs. Turns out not all medications are identical.

[zasdffaa]

Yep, never taken SNRIs - for me it was straight prozac. Side effects while on it weren't pretty though.

[hammyhavoc]

Anecdotal. n+1.

[zasdffaa]

I'm not sure what you're saying?

[User23]

They can however prescribe basically harmless pills that do more or less nothing. Low dose vitamin pills are sometimes used for this purpose.

Whether or not it's ethical for a doctor to tell a depression patient that the depression is caused by a treatable vitamin deficiency is another matter. Then again, maybe it really is caused by a lack of micronutients. After all we really don't understand depression very well.

[CharlesW]

The AMA says they can if the patient is informed of and agrees to their use. But wouldn't that significantly impact their effectiveness?

[HWR_14]

Why wouldn't doctors be able to prescribe placebos?

[bratsche]

I’ve tried a number of antidepressant drugs and so far not been able to notice much difference with any of them.